INDEX S.# TOPIC Pg # 1. ANNUAL SYMPOSIUM PROGRAMME 1 Welcome speech of the Managing Trustee 2. 2 (Dr. S. Razi Muhammad Oral Presentations 7 (i) Free papers – Scientific Session – I 3. 17 (ii) Free papers – Scientific Session – III – A (Medicine) 36 (iii) Free papers – Scientific Session – III - B (Surgery) 4. Poster Presentations (original papers) 53 5. Poster Presentations (case reports) 100 6. State-of -Art Lecture 115 7. Patients’ Welfare Club and MMC Hospital (Urdu) 117 8. Charity Work 118 ANNUAL SYMPOSIUM PROGRAMME Date: 13th August 2008 PROGRAMME VENUE TIMINGS Registration Entrance of 1st Floor 08:30 – 09:30 Scientific Session – I (Free Papers) Followed by State-of-Art Lecture by Prof. Tariq Nadeem Ansari Prof. Hasan Memon Auditorium 09:00 – 10:30 (Rawalpindi) Cancer, a disease not a death sign Inauguration Session – I (Opening of Exhibition and Poster Exhibition and Poster Halls 10:30 – 11:30 Viewing) Inaugural Session –II Prof. Hasan Memon Auditorium 11:30 – 12:30 Recitation of Holy Quran Theme speech and Welcome address : Prof. Syed Razi Muhammad (Managing Trustee) Scientific work being presented by : Dr. Syed Zafar Abbas MMCians in the Symposium (MS-MMCH & Chairman Scientific Committee) Speech by Chief Guest : Dr. A. Rahim Soomro (DCO, Mirprukhas) Vote for thanks : Prof. Ghulam Ali Memon PROGRAMME VENUE TIMINGS Prof. Hassan Memon Auditorium Scientific Session – II 12:30 – 14:00 (A) State of Art Lectures: (i) Dr. S. Qamar Abbas (UK) – Effective Communication Skills Lunch, Prayer, Poster Viewing, Masjid, Hospitality Suite, Poster 14:00 – 15:00 Exhibition Hall Prof. Hasan Memon Auditorium Scientific Session – III (Free Papers) 15:00 – 16:30 (A) Satellite Symposium Pakistan Society of Surgeons, Auditorium (B) – Ground Floor 15:00 – 16:30 Mirpurkhas Chapter State-of-Art Lecture by Dr. Tayyab Memon (UK) Prof. Hasan Memon Auditorium 16:30 – 16:50 Cardio-pulmonary Resuscitation Awards Ceremony Prof. Hasan Memon Auditorium 16:50 – 17:30 • Points will leave MMC from main gate for city at 18:00 • All authors are requested to stand by their posters during Poster viewing time to answer any questions. 1 “Health Policy and the deprived regions of Pakistan – Past, present and future” Dr. Syed Razi Muhammad MBBS, FRCS (ED), FRCS (GI), Dip. Urology (London) Managing Trustee, Muhammad Foundation Trust Honourable President of the Symposium, Pro Vice Chancellor University of Sindh, respected chief guest honourable principal and members of the faculty, distinguished guests including representatives of media and drug companies, dear students, ladies and gentlemen. Assalam-o- alaikum. On behalf of Muhammad Medical College and Muhammad Foundation Trust, I welcome you all to the sixth Annual Symposium at MMC. As you are aware, we hold this Symposium every year starting from 4th year of establishing Muhammad Medical College. Hence now that MMC is a decade old, having produced 5 batches of doctors and now admitting 11th batch of students, I have a great news to tell you. Only 11 days ago, i.e. on 2nd August 2008, Pakistan Medical &Dental Council, after comprehensive inspection appreciated the increase in faculty, hospital beds and other teaching facilities, and officially permanently doubled the admission rights to Muhammad Medical College to 100 students. Hence Muhammad Medical College now has the same full recognition that was earlier given to only some very renowned institution like King Edward, Dow and Liaquat Medical Colleges and now that too with admission rights equal to institutions like Aga Khan, Baqai and Ziauddin Medical Universities. Ladies and gentlemen, Muhammad Medical College is the first and so far the only Medical College of Pakistan established in a deprived rural & poor urban region. However, Mirpurkhas is a place of very friendly people. It has never seen problems on the basis of religion or language. Hence parents from all over Pakistan and abroad feel comfortable and happy to send their children to MMC for high quality Medical Education in a peaceful atmosphere, something that is sadly missing in larger cities of Pakistan. As the symposium progresses, you will see scientific research done by scholars from all over Pakistan and abroad and a good amount of local research done by faculty and students of MMC. Hence you will be able to compare and contrast the research done locally, nationally and internationally. Those of you who have been here before, will be able to see and compare the quality of research at MMC done in the past and present. Soon, our Medical Superintendent, Consultant Gastroenterologist and Professor of Surgery, Dr. Syed Zafar Abbas will also present a brief of the papers presented in this symposium. The theme of a Medical Symposium is usually a philosophical one. We always ensure that our theme provides us with an opportunity to exploit our unique position. This time too, with the arrival of the new democratic government which has a large number of representatives from deprived regions of Pakistan, we decided that our symposium should focus on the health policy for the deprived regions of Pakistan and compare the past and present and make suggestions for future. Obviously this is a topic that cannot and should not be devoid of bitter facts. However if we do not speak for the health problems and disparity on the distribution of the health resources, then who will? And if our present government will not solve the problems of deprived people then who will? As the poet has said: 2 Ladies and gentlemen, health policy is made so that the available resources should be distributed in just and transparent manner in an intelligent way so that maximum benefit could be provided to all or nearly all. Unfortunately Pakistan has very limited resources. The health budget amounts to nearly 1% of GDP that equals 19 billion RS or $ 267 million. It looks peanut when compared with 16% of GDP of USA amounting to $2.1 trillion. If you include private spending and then translate spending per person, it amounts to over $14000 per person per year by USA and about $85 per person per year in Pakistan. However in Pakistan, government spends only $21 and rest of $64 come from personal spending. Hence it is hardly surprising when we see pathetic state of health of our nation. With average life about 20 years less than developed countries, we find following figures: • 26,000 young mothers die unnecessarily during childbirth each year. • 83 out of 1000 children born die before reaching first birthday. • 3 out of 4 people die of infective causes. Unfortunately, with powerful groups protecting their interests, Pakistani governments have not been able to distribute its meagre resources in a just pattern. Look at following facts: • Although 70% or 100 million people live in rural areas, only 20% of health budget is spent on them. Rural/ peri-urban areas have only 15% of practicing doctors and 18% of hospital beds. 85 per cent of all practising doctors work in the cities, which comes to a doctor-population ratio of 1:1801. The rural doctor-population ratio happens to be a pathetic 1:25829. Similarly, only 23 per cent of the hospitals in the country are located in rural areas and only 8,574 hospital beds (18 per cent of total) are available to a population of 80 million. • Private sector contributes for nearly 75% of healthcare facilities in Pakistan. Yet less than 20% of private sector spending on health is on 70% rural population. • In dollar terms, 227 USD are spent on an average Pakistani living in urban areas and only 24 USD in a person living in rural Pakistan in a year. As a result of this misdistribution of resources, the disease pattern and cause of death is so much different in rural and poor urban regions. It is claimed that 75% of deaths occur in Pakistan due to infectious diseases. Those who have worked in both urban and rural regions of Pakistan will testify that whereas in urban regions, infectious diseases seem to be the cause of 50% of deaths, in rural regions, this may be as high as 85%. while in urban areas drinking water is available to 80 per cent of the people, it is as low as 45 per cent in rural areas. Proper sanitation facilities are available in urban areas to 53 per cent of people, but in rural areas only 10 per cent have such facilities. So we see that there is a great discrepancy between health condition and distribution of health resources in urban and rural population. This clearly shows that health policies of the past failed to address the health needs of the rural population of Pakistan. What should we do about it? Fortunately, there are successful precedences from other countries. For example • Canadian government has identified 5 disadvantages of its rural population that should be taken into account while formulating health policy. People living in rural population: 1. live in poorer socioeconomic conditions 2. have lower educational attainment 3. exhibit fewer healthy behaviours 4. have a higher risk of certain chronic diseases 5. have lower life expectancy and higher overall mortality rates 3 • United States of America has established Office of Rural Health Policy (ORHP) in 1987. ORHP promotes better health care service in rural America. Congress charged the Office with informing and advising the Department of Health and Human Services on matters affecting rural hospitals, and health care, co-ordinating activities within the department that relate to rural health care, and maintaining a national information clearinghouse. Unfortunately, there has never been any serious attempt to abolish the discrepancy between health condition and distribution of health resources in urban and rural population. The last heath policy issued in proper format in 2001 narrated that the overall national vision for the health sector is based on "Health-For-All" approach.